Obsessive-Compulsive Disorder and the “Root of the Problem”

If I only knew what caused my OCD I could fix it — not!

The elusive root of the problem

What caused my OCD?

Obsessive-Compulsive Disorder (OCD) is often shrouded in mystery, as sufferers struggle to understand the cause of their disorder. Already prone to "over-thinking," many believe that if they can determine what caused their brain to go awry, they can figure out a way to fix it. People with OCD have been known to spend hours ruminating to find "the root of the problem."

Many will report their OCD was triggered by a particular life event. Common triggers I have heard from clients include traumatic events, cannabis use, and random interactions that planted a seed of doubt in the mind that would not go away.

It is true that the specific content of obsessions can be influenced by events that occur in a person's life, and this can be seen in cross-cultural studies of OCD. For example, OCD sufferers in Islamic cultures are more likely to have religious compulsions. However, Islam is not the reason the person contracted the illness, it is only the mask worn by a disorder that, like a chameleon, tries to blend into its surroundings.

Predisposed to obsess

Interestingly, people who have had more stressful life events before the onset of OCD are more likely to engage in checking and symmetry compulsions — perhaps as an attempt to impose a degree of order in a world filled with increasing unpredictability. However, despite the temptation to figure it all out, it is not possible to identify the exact cause of OCD in any particular person. OCD is not caused by religion, culture, or late toilet training. It is caused by a complex interaction of genetics, environment, personality, and stressors. There is no one psychological factor that causes OCD in a particular person, and likewise no single gene that can be identified and excised. Some people are born with a predisposition to OCD, and then a combination of life events light the fuse. In other cases, the onset was like a ticking time-bomb, destined to go off at the specified hour, regardless of the circumstances. Although most people can remember having some symptoms as a child, the average age of onset for OCD is around the age of 20 — potential evidence for a sinister genetic plan unfolding at an appointed time.

Cause does not lead to cure

Although negative life events, such as a psychological trauma, can be the catalyst for the onset of the disorder, psychological exploration of these events is not curative for OCD. These types of explorations are typical of treatment approaches, such as psychodynamicpsychotherapy, that are focused on understanding a person's past and unconscious as a route to resolving emotional problems. The goals of these forms of therapy include uncovering hidden motivations and gaining insight, leading to their designation as "insight-oriented therapies."

Unfortunately, insight alone is not enough. People with OCD tend to be introspective and typically have already spent a great deal of time and effort ruminating about the origins of their disorder. In fact, this sort of rumination can be a mental compulsion, which will actually worsen the symptoms.

One problem is that too many therapists unwittingly participate in this counterproductive process. In my own practice, I have seen clients who previously spent years in therapy, as time and money were wasted trying to find the elusive root of the problem. And the irony is that even if a root were found, there is no evidence that an "ah ha!" moment would lead to resolution of the symptoms. Over a hundred years of research has shown us that psychodynamic approaches are just not enough for OCD. Unfortunately, even cognitive-behavioral therapists are sometimes sucked into the temptation to dig for the roots. A little digging might help the client feel he understands himself better, but it won't be enough to make the symptoms go away.

Root of the problem does not equal core fear

People with OCD should be encouraged to refocus their energies on combating the disorder through exposure and ritual prevention (EX/RP), a type of cognitive-behavioral therapy designed specifically for OCD. Digging for the "root" of the problem should not be confused with identifying the client's core fear, which in fact is essential in guiding the development of appropriate exposure exercises. There's no cure for OCD, but focused EX/RP is the best treatment science has to offer those plagued with distressing obsessions and repetitive compulsions.

National Institute for Health and Clinical Effectiveness. (2006). Obsessive-compulsive disorder: Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. The British Psychological Society & The Royal College of Psychiatrists. www.nice.org.uk

I also disagree quite strongly with this article. I have had OCD since early childhood and have spent years doing ERP and CBT. Jimwell is exactly right in saying that obsessions and compulsions will simply morph into something else when these treatment approaches are used. ERP and CBT focus on symptom management and it is essential to focus on the roots.

Jimwell is exactly right in saying that obsessions and compulsions will simply morph into something else when these treatment approaches are used

No, it's the opposite, and the article is 100% correct. You have to get rid of the obsessive behavior. What you're saying makes no sense. If you try to fix every trigger, your obsessive behavior is going to remain. But, if you fix your obsessive behavior, the trigger will not matter. Every person I have ever talked to who has problems with ERP were doing something incorrect. ERP takes awhile to learn, and a lot of doctors are bad at teaching it. I've had severe OCD since I was born and wasted so much time focusing on my triggers. I am now 95% better using ERP alone.

anytime i read an article on psychologytoday it is always a bummer for the person who is diagnosed. they really try to make things sound really really bad. horrible place to come if you are looking for some relief as an ocd sufferer.

I had obsessions since I was a kid, like not stepping on peoples shadows or pavement cracks cos it's disturbing and something bad might happen but in my adult age ocd targets my relationships, so called rocd, all of my relationships ended badly because of it and in all of them relapse started with moderate to heavy use of cannabis. It seems that thing is pretty huge catalyst for ocd

I find this article quite disturbing, this "Doctor" has such a narrow, singular, paradoxical and all-round negative perspective that I think her words can do more harm than good to not just the readers here but also to her patients.

The use of terms/phrases such as "ticking time bomb waiting to go off" and "Sinister Genetic Plans" are not only overly dramatic and unprofessional, the doctor clearly has no empathy and considerations on the article's primary group of readers - sufferers of OCD, which many are highly sensitive people (there are studies linking HSP to OCD).

And just look at the last sentence:

"There's no cure for OCD, but focused EX/RP is the best treatment science has to offer those plagued with distressing obsessions and repetitive compulsions".

I'm sorry? Are you trying to help people or to push them over the edge? How arrogant is this comment? There is no cure? Just because you haven't found it?

I am a long term sufferer of OCD and Anxiety since childhood, and I have personally been in and out of it, sometimes things get really bad, but sometimes I feel I'm totally cured. I'm not a professional therapist, but I can tell you this, I had times when I feel not bothered at all by any OCD symptoms, sometimes this can last for months even years, so the CURE IS OUT THERE, just that scientists and therapists haven't fully figured it out yet!

And through out the countless therapists and doctors that I went through, some are very nice, kind and understanding, even though the solutions they provide don't always work, but that is fine, I am a highly sensitive person, and I could feel deeply, they are doing the best they possibly can, and I'm always happy to see them; this mental support alone is a huge boost to our positive feelings and courage, it alone is better than any drugs.

And yet, there are some "therapists" are just plain sociopaths, they feel nothing, they tell nothing, they look at you once and tell you exactly what they think you are and try to put you onto the strongest drugs there is, because they think you are an idiot. And the author of this article is clearly one of those.

My name is Jasmine and I am contacting you from the office of Dr. Monnica Williams, the author of this article. Would you be interested in meeting with Dr. Williams over the phone, to discuss some of your concerns? Please let me know, and I'd be happy to set a meeting up. You can respond to this post, or call our office at (502)403-7818.

Hi Jasmine I have sent an email to Dr. Williams' UCONN email address which contains some questions I have after reading this article. It would be great if she could respond and address these questions.

I have a diagnosis of PTSD with a secondary diagnosis of OCD. For many years I was only diagnosed with OCD, I had gone silent about the trauma. I was lucky in some sense that I was diagnosed with OCD right away, from my first visit to a psychiatrist. The author is right in saying that at times "talk therapy" can only exacerbate certain forms of OCD... However in general this is in cases where the patient is not diagnosed with OCD and the practitioner takes the obsessions seriously and seeks to find the root cause. So for example someone who is afraid of being a serial killer, would spend countless hours with a psychologist who didn't know what they were doing trying to figure out if the patient suffered from conduct disorder as a child and what his relationship with his mother was like. This would only strengthen the patients belief in the efficacy of his obsessions further sending him down the oath of needing to mitigate them with ever increasing compulsions. A trained psychologist or psychotherapist who was adept at recognizing the symptoms of the disorder would not take this approach tho talking with the patient with their experiences of OCD would be a healthy part of establishing trust and understanding the nature of their clients experience. Cbt being even more effective in helping the patient, perhaps with a mindfulness practice.

When I finally realized that my OCD was the direct result of an intense one year experience of trayma. I was able to start unlinking the ways that my triggers were looped into the undiagnosed trayma and ignored trayma. Suddenly my intense need to have doors locked made a lot more sense, of course I needed to be alert at all times when I wasn't in a situation where I knew the door was unlocked. I had become afraid that I was a predator/could harm others because psychologically it was much safer than being constantly afraid of the outside threat. The numerous experiences of being assaulted after my anxiety disorder took hold were not experienced in the way a normal person would experience say... Being sexually assaulted by a cop (yes that happened) I was relieved instead that I was drunk and perhaps more significantly had not harmed anyone else. I laughed the experience off, continuing to experience many more of these "light" traumas in the coming years. Finally I randomly visited the Facebook page of the class I had belonged to my freshman year of college and the pieces started to fall into place. If a man was driving his car at about five miles per hour behind me so that he could check me out I would suddenly feel triggered not having even seen or noticed the car behind me and would need to check (rewalk) the space around me to make sure there was no one around at the time of the trigger and that I hadn't harmed anyone. And then I would notice the creep in the car and he would suddenly speed up. These triggers became more apparent to me, and the absolute frequency of them was astonishing.

Precious attempts at exposure and response therapy had left me wanting to jump out of cars into moving traffic. On the one hand maybe I wasn't ready, on the other hand maybe the compulsions were there for a reason, as the author said "to protect me." To rip the bandaid off a wound that hasn't healed with no salve, disinfectant or care is dangerous at the least, and downright criminal at worst. With my initial treatment of drug therapy I found that my anxiety was just trapped inside, I could appear normal b ut never really felt good, rarely at least. It wasn't until I was able to identify what the author call "the root" of the problem that I was able to effectively begin cbt, with a trayma therapist. I have found that a great deal of my function improved as I worked on it. Writing and not re-writing Facebook posts became easier. More recently I have been able to identify where something creates a "feeling of contamination" because a boundary has been crossed and have been able to avoid a full on anxiety attack, and at times have found it easier to de-link almost entirely, successfully completing "an exposure," and experiencing what was once at times a twenty four hour anxiety attack as the beautiful kind potential and combination of sadness and joy and hope that comes with the courage to believe in ones worthiness for healing.

To all the OCD people reading this. Healing is possible. It is out there, or deep within for all of thus. We have the keys... And it is perhaps our sensitivity that makes us and gives us the greatest potential to reach the people with our knowledge with the greatest capacity to create evolving healthy and hopeful scientific studies that affirm what each broken person deserves to know is true. Wellness is possible. I wrote this with great love, for myself and for the fellow sufferers and even for the phd who maybe did a poor job of compiling information in this article b ut perhaps had the goal of creating healing nonetheless. I write this and say all of this leaving you with this message of hope... There was a time where I could barely write a paragraph. Healing is a process. You are worthy.

there's a scientific american article on this titled 'compulsions can follow trauma', stating that in the subtype where ocd patients have a history of trauma, compulsive behaviour can help alleviate the ptsd symptoms. In this case it is advised to revisit traumatic memories in a safe space to reduce some of the intense emotional content.